Common Trizetto Rejections
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Last Modified on 08/18/2021 3:53 pm EDT
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After submitting your 837 file(s) to the clearinghouse, it is recommended that you follow up by logging into the clearinghouse's website to confirm the receipt of the claim file(s) and to check for any front-end clearinghouse rejections. Clearinghouses typically advise that you wait 24 hours prior to checking for your claim files, but some may be there sooner and it may vary by clearinghouse. Listed below are some of the common clearinghouse rejections from Trizetto that you may experience when you are first implementing the Billing Engine. These rejections may occur after go-live, if you are adding new information to your system as your staff changes, or you add new insurance payers.
NPI Issues
| Rejection Reason | Explanation | Billing Engine Field Changes | Path |
| Rendering Provider Identification Code Qualifier must be XX. 2310B.NM1*08 | The Rendering Provider (staff member whose name is attached to the Line Item) is not set up with an NPI number in the Billing Engine. | In the Employee/Contractor Form, add an NPI number and enter XX in the 837 Code Qualifier field. | Maintenance and Setup > Employees > Employee/Contractor > Employee Contractor > Select the Employee Name > Ok button > Edit button |
| Rendering NPI # is invalid | The staff member's NPI is present but is not valid (usually due to a typo). | In the Employee/Contractor Form, edit the NPI number and enter XX in the 837 Code Qualifier field. | Maintenance and Setup > Employees > Employee/Contractor > Employee Contractor > Select the Employee Name > Ok button > Edit button |
Billing Provider/Site Setup
| Rejection Reason | Explanation | Billing Engine Field Changes | Path |
| Billing Provider SSN and EIN must be 9 numeric and cannot be all 0s or 9s. | The Agency Tax ID is missing. | In the Agency Form, add the Federal Tax ID No. | Maintenance and Setup > Agencies/Provider Network > Select the Agency Name > Ok button > Edit button |
| Billing provider address is required. Billing provider City, State and Zip code is required. 2010AB N3, N4. | The Agency address is missing. | In the Agency Form, complete the Address, and City / State / Zip fields. | Maintenance and Setup > Agencies/Provider Network > Select the Agency Name > Ok button > Edit button |
Payer ID
| Rejection Reason | Explanation | Billing Engine Field Changes | Path |
| Valid Payer ID is required please change from XXXX to YYYY | The Insurance Payer ID is not correct. This usually means that you may have used a payer ID from your old system. Trizetto has its own payer IDs. | In the Insurance Master Form, edit the Payer ID field. | Maintenance and Setup > Insurance > Insurance > Select the Insurance > Ok button > Edit button > Page 2 |
| You are sending over institutional claims but you have professional payer IDs on the claims. If you are sending institutional claims, you must use institutional payer IDs. | There are different Payer IDs for Professional and Institutional claims for Trizetto, and they need to be used appropriately. | In the Insurance Master Form, edit the Payer ID field. | Maintenance and Setup > Insurance > Insurance > Select the Insurance > Ok button > Edit button > Page 2
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| Payer ID # is required and must be valid. | There is no Payer ID on the Insurance Master Form. | In the Insurance Master Form, add the Payer ID. | Maintenance and Setup > Insurance > Insurance > Select the Insurance > Ok button > Edit button > Page 2
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